P134 Point of care ultrasound accurately distinguishes inflammatory from non inflammatory disease in patients presenting with abdominal pain and diarrhea
Notice bibliographique
Résumé
Background: There is a considerable overlap between symptoms of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). It is important to have access to non-invasive, safe, low cost diagnostic tools to differentiate IBD from functional abdominal symptoms such as IBS, and avoid unnecessary invasive investigations including endoscopy. Point of care ultrasound (POCUS) of the bowel is not widely accessible in North America, but is routinely used in Europe. The aim of this study was to evaluate the accuracy of POCUS in the detection of luminal inflammation compared to gold standard ileocolonscopy in patients presenting with undifferentiated lower gastrointestinal symptoms. Methods: A prospective, single- center study of consecutive patients presenting to the GI clinic with symptoms high risk for IBD were evaluated to differentiate IBD from IBS. POCUS was performed, clinical data recorded and C-reactive protein measured prior to ileocolonoscopy, which served as the gold standard. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for POCUS. Results: Eighty-six patients with undifferentiated symptoms of diarrhea (76.7%), abdominal pain (62.8%) and weight loss (18.6%) were evaluated. Nocturnal symptoms (15.1%) and incontinence (11.6%) were infrequent (Table 1). Ileocolonoscopy was negative in 72 patients confirming IBS, 2 patients had diverticulosis, while 12 revealed findings of active endoscopic disease consistent with IBD, confirmed on pathology, 11 with CD and 1 with UC, as well as microscopic colitis (N=8), diverticulosis (N=1), ischemic colitis (N=2) and one solitary rectal ulcer. The overall sensitivity, specificity, PPV and NPV of POCUS were 83.0%, 100%, 100%, and 97.37%, respectively. In cases where POCUS was positive, POCUS predicted the severity of inflammation as seen on ileocolonscopy accurately with correlate findings of 90% (9/10 cases accurately predicted severity). The accuracy of POCUS for predicting IBD was much better than CRP, as the sensitivity of CRP was only 37.5%, specificity 76.2%. Wait time for endoscopy for patients with a positive POCUS was shorter with a median of 3.5 weeks, compared to 4 weeks for those with a negative POCUS. Table 1. Demographics Table 2. Sensitivity, specificity, accuracy, PPV and NPV of POCUS relative to ileocolonoscopy Conclusions: Bedside POCUS is a useful triage tool, better than CRP in disease prediction, helpful to accurately detect the presence and severity of inflammation in the bowel and thus differentiate IBD from IBS. The detection of ileal disease was more accurate compared to colonic disease and future studies should be completed with addition of fecal calprotectin to optimize detection rates and overall accuracy.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».